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� <br /> E��CTRICAL PERMIT AP�LICATiC}N <br /> �' CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,INA 982�1 <br /> (P)425-257-881C� } FAX 425-257-�857 � (E}everetteps@�verettwa.gav � www.everettwa.�ov/permits <br /> PRaJECT SITE �fi1�1�►R11�ATlON �� <br /> PROJEGT ADDRES�a: �S SW EV@I"��� MaI� BIVtj, Everettf 1/t!A �8204 <br /> BUILDiNG AREA{if residentiai; new construction,remodei,or addition)3�d� SF <br /> BUILDiNG TYPE: ❑SPR-0ETACHED ❑ SFR-A7TACHED ❑ DUPLEX ❑MULTf-FAMILY-#Of UNlTS: �ZI COMMERCIAL <br /> use oF Bui�oiN�: Medical Facility <br /> ELECTRICAL APPLICATION INFORMATION <br /> CQNTRACT PRICE OF WORK: $ a17,130.00 <br /> NUMBER OF DEVICES if iow valta e ; 65 <br /> FfRE ALARM? ❑YES �NC> <br /> ASSOGfA1"ED BUILDING PERMIT# if a plicable : <br /> DESCRIPTION OF WORK: lnstall telecommunications cabling in Kids Area <br /> CONTACT IN�tfRMAT10N <br /> CtiWNER MAME: TENANT NAME If Cammercial}: V�d�N�Blth <br /> OWNER MAIIING ADQRESS: sr��ET <br /> C�TY STATE <br /> 21P <br /> QWNER PHONE: QWNER EMAIL: <br /> CONTRACTUR NAME: POW@t'CO171, IIIC. <br /> CONTRACTOR ADDRESS: sTR��r 22�22 201h AVE:. SE �#152 <br /> c,n. Bothell s�ArE WA Z,� 98021 <br /> CONTRAGTOR PHONE: 425-487-8549 CDNTRACTOR EMAIL: ICfIC1�ICII�CaIIpOW6CCOtTt.COR1 <br /> CQNTRACTOR LIC.#{REQU€REC�): ���`✓�R�*937MJ C1'T'Y pF EVERETT BUSINES5 LIC.#{REQUIRED): a4041 1 <br /> PREMARY CONTACT: C�pWNER (,a CQNTRACTOR �p7HER{Please Specity) <br /> CONTAC7 NAME: CQNTACT PHONE: 206.391.9955 <br /> C�1 S�t1tefOrd CONTACT EAAAlL:��ganfe#ord�,7a callpowercatn.eOm <br /> AGREEMENF:t hereby cenrfy tha!1 have read and exami�ed this appJicatr"on ar�d know tJre same to 6e frue and carect. AU Arrnisions of taws and ordina�es govsrnnrg rhr's type <br /> af wcrk wilt be compteted whether sp�cified herei�>or rzot. 7'he grandng of a permic dces not presume to glve authorrty to violaie or caneel the provisions of any other s�ate ar <br /> locat 1aw regulating construction or the pefltumance ot construCtion. 7hat t am autharrzed by th�awner of this proparty:o perCarm the wark tor wnich apptrcatia�is made and/ <br /> comply with the State Contractors Law 18.�7 RCW and 296.200 WAC. <br /> > Crty ot Everet�pfllciat t/s�pnly <br /> i ,�� _ l ',7 ���tw�-r� �_.,.. �. <br /> � <br /> : _ ` � � � C <br /> � /, e _ ..r�� � ! ��,--^� /��� ,� — l �J -f �� <br /> .�` - ,'lr-9''' � ���. ' � 1 <br /> OwnerlAuthorized Agent Signature Oate (Revised 9,'2.3.'2098) <br />